HPV papilloma in the lung in a Crohn's disease patient treated with Infliximab

A 74 year old male patient was admitted to the emergency room with a gastrointestinal obstruction. His medical history revealed multiple abdominal surgeries with a Hartmann's resection for perforated diverticulitis, transabdominal prostatectomy, cholecystectomy and correction of an umbilical hernia. Giving his medical history of multiple abdominal surgeries a temptative diagnosis of gastrointestinal obstruction due to adhesions was made. Our patient underwent a laparotomy and multiple adhesions were treated with adhesiolysis. During the laparotomy a subobstructive terminal ileum was seen with a macroscopic appearance of Crohn's disease with creaping fat and active inflammation. A stricturoplasty was performed and biopsies showed the presence of granulomas. An oral treatment with budesonide 9 mg/ day, tapering with 3 mg every month, was started. Three months later, a colonoscopy showed active terminal ileitis with ulcers. On magnetic resonance enterography there was persistent inflammation of the terminal ileum with substenosis, prestenotic dilatation of the small intestine and skip areas. At that time 6-mercaptopurine was started. After two months 6-mercaptopurine had to be stopped due to hepatotoxicity and Infliximab was started. Due to a positive tuberculosis skin test, start of Infliximab was postponed for 6 weeks and prophylactic treatment with Nicotibine was started.